简介：AbstractBackground:Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.

简介：AIM:Toinvestigatechangesinfundusexcyclotorsionafterinferiorobliquemyectomyormyotomy.METHODS:Therecordsof21patientsundergoingstrabismussurgerybyasinglesurgeonbetween2009and2012wereexamined.Onlypatientswhohadundergoneaninferiorobliquemyectomyormyotomy,withorwithouthorizontalrectusmusclesurgery,wereevaluated.Digitalfundusphotographswereobtained,andtheangleformedbyahorizontallinepassingthroughtheopticdisccenterandareferencelineconnectingthefoveolaandopticdisccenterwasmeasured.Associatedclinicalfactorsexaminedincludeageatthetimeofsurgery,presenceorabsenceofaheadtilt,degreeofpreoperativeverticaldeviation,torsionalangle,inferiorobliquemuscleoveraction/superiorobliquemuscleunderaction,andsurgerylaterality.Whethertheprocedurewasperformedaloneorincombinationwithahorizontalrectusmusclesurgerywasalsoexamined.RESULTS:Meanpreoperativetorsionalanglewas12.0±6.4°,whichdecreasedto6.9±5.7°aftersurgery(P<0.001,pairedt-test).Torsionalanglealsodecreasedfrom15.1±7.0°to6.2±4.3°inthemyectomygroup(P<0.001,pairedt-test)buttherewerenosignificantchangesinthemyotomygroup(P=0.093,Wilcoxonsignedranktest).Multivariablelinearregressionanalysisshowedthatpreoperativetorsionalangle,degreeofinferiorobliqueoveraction,andageatsurgeryindependentlyandsignificantlyaffectedpostoperativetorsionalangle.CONCLUSION:Meantorsionalangledecreasedafterinferiorobliquemyectomy.Degreeofpreoperativetorsionalangle,inferiorobliqueoveraction,andageatsurgeryinfluencepostoperativetorsionalangle.

简介：BackgroundVocalcordmovementdisorder(VCMD)isalaryngealdisordercharacterizedbyparadoxicaladductionofthevocalcordsduringininspiration,expirationorboth.ThenursingexperienceofpatientswithVCMDafteraorticdissectionsurgeryislimited.MethodsWeretrospectivelyanalyzedtheclinicaldataandnursingrecordsof269patientsafteraorticdissectionsurgeryinGuangdongGeneralHospitalbetweenMay2010andMay2012.Weobservedthepatients’pronunciation,andjudgediftherewasdysphagiaundergoingwaterdrinkingtesttwohoursafterextubation,toconfirmwhetherpatientshadVCMD.ResultsSeventeenpatientshadVCMDafteraorticdissectionsurgery,ofwhom2sufferedhoarseness,3haddysphasiaand12hadbothhoarsenessanddysphasia.Aftertimelytreatmentandcarefullynursing,allthepatientsrecoveredwell.ConclusionsWiththeenhancedcareofpatientswithaorticdissection,observinghoarsenessappearanceanddrinkingexperimentimmediatelyafterextubationcandetectVCMDassoonaspossible.Furtherrehabilitationtrainingandpsychologycarecanpreventbuckingandaspirationeffectively,andpromotingrecoveryandimprovingpatient’slifequality.

简介：AbstractPancreatic ductal adenocarcinoma (PDAC) represents one of the most aggressive malignancies, and the majority of patients with PDAC present with metastatic disease, mainly in the liver, at the time of diagnosis. Surgical resection is the only treatment that can offer prolonged survival and possible cure. However, the indications for surgery for patients with PDAC metastases remain extremely limited to highly selected patients with localized disease, and metastatic disease is generally regarded as a contraindication to surgery. Recently, however, the advent of more effective chemotherapy has changed the treatment strategy for metastatic PDAC. In fact, cases in which resection of synchronous or metachronous PDAC liver metastases lead to prolonged survival in highly selected patients have been reported. In this review, we provide current data regarding survival outcomes after surgery, and discuss the role of surgical resection and selection criteria for patients with PDAC liver metastases in the modern era.

简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：Giventhehighincidenceofcervicallymphnodemetastasisindifferentiatedthyroidcancer(DTC)andtherapidlyincreasedimportanceofneckdissectioninDTC,thejournalofGlandSurgeryislaunchingaspecialissueon'NeckDissectioninDifferentiatedThyroidCarcinoma'inNovemberIssueof2013,

简介：无

简介：AbstractObjective:To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.

简介：Objective:Toevaluatetheshort-termoutcomesofvideo-assistedthoracicsurgery(VATS)forthoracictumors.Methods:Thedataof1,790consecutivepatientswereretrospectivelyreviewed.ThesepatientsunderwentVATSpulmonaryresections,VATSesophagectomies,andVATSresectionsofmediastinaltumorsorbiopsiesattheCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesbetweenJanuary2009andJanuary2012.Results:Therewere33patientsconvertedtoopenthoracotomy(OT,1.84%).Theoverallmorbidityandmortalityratewas2.79%(50/1790)and0.28%(5/1790),respectively.TheoverallhospitalizationandchesttubedurationwereshorterintheVATSlobectomygroup(n=949)thanintheopenthoracotomy(OT)lobectomygroup(n=753).Therewerenosignificantdifferencesinmorbidityrate,mortalityrateandoperationtimebetweenthetwogroups.Intheesophagealcancerpatients,nosignificantdifferencewasfoundinthenumberofnodaldissection,chesttubeduration,morbidityrate,mortalityrate,andhospitallengthofstaybetweentheVATSesophagectomygroup(n=81)andopenesophagectomygroup(n=81).However,theoperationtimewaslongerintheVATSesophagectomygroup.Inthethymomapatients,therewasnosignificantdifferenceinthechesttubeduration,morbidityrate,mortalityrate,andhospitallengthofstaybetweentheVATSthymectomygroup(n=41)andopenthymectomygroup(n=41).However,theoperationtimewaslongerintheVATSgroup.ThemediantumorsizeintheVATSthymectomygroupwascomparablewiththatintheOTgroup.Conclusions:Inearly-stage(I/II)non-smallcelllungcancerpatientswhounderwentlobectomies,VATSiscomparablewiththeOTapproachwithsimilarshort-termoutcomes.Inpatientswithresectableesophagealcancer,VATSesophagectomyiscomparablewithOTesophagectomywithsimilarmorbidityandmortality.VATSthymectomyforMasaokastageIandIIthymomaisfeasibleandsafe,andtumorsizeisnotcontraindicated.Longerfollow-upsareneededtodete

简介：ObjectivesTotestthefeasibilityoftheuseofhighthoracicepiduralanesthesiaasasoleanestheticinpatientsundergoingoffpumpcoronaryarterybypasssurgery,avoidinggeneralanesthesia.MethodsBetweenOctober2002toApril2003,twentyfivecasesunderwentbeatingheartcoronaryarteryrevascularizationwithoutendotrachealgeneralanesthesia,usinghighthoracicepiduralanesthesiaandanalgesia.Allthepatientsunderwentepiduralcatheterizationontheeveningbeforethesurgery.ResuitsThepatientsinallreceived71grafts(singlen=11,doublen=5,triplen=6,quadruplen=3).Sixpatientsunderwentrepeatcoronaryarterybypass.Exceptonewasconvertedtogeneralanesthesiaandcardiopulmonarybypass,theotherpatientsunderwentoff-pumpcoronaryarterybypassgraftsurgery,2patientsunderwentgraftingvialeftthoracotomy(MIDCAB)andtherestthroughmidsternotomy.Therewasnomortality.Meanlengthofstayintheintensivecareunitwas16.2(4.2hoursandhospitalwas3.0(1.2days.ConclusionsOurexperienceconfirmsthefeasibilityofperformingmuhiplecoronaryarterybypassesinconsciouspatientswithoutendotrachealgeneralanesthesia.

简介：ObjectivesToanalyzetheriskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(HCH).MethodsClinicaldatafrom162HCHpatientswhounderwentsurgerywereretrospectivelyanalyzedforthecorrelationbetweenrecurrenthemorrhageandgender,age,durationofhypertension,historyofdiabetesmellitusandhypercholesterolemia,siteandvolumeofhemorrhageandpost-surgicalsystolicanddiastolicpressure.ResultsPost-surgicalrecurrenthemorrhagewasfoundin24patients.Withmulti-variateregressionanalysis,historyofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressurewereprovedpositivelycorrelatedtotheincidenceofrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(P<0.05).ConclusionsRiskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhagearehistoryofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressure.Patientswithdiabetesandhypertensionareathigherriskforcerebralhemorrhageorpost-surgicalrecurrenthemorrhage.Effectivecontrolonbloodpressureaftersurgerycanreducetheincidenceofrecurrenthemorrhageaftersurgeryforhypertensivecerebralhemorrhage.

简介：DearEditor,WereadthearticlebyLeeetal~([1])withgreatinterest.Wewouldliketocongratulatetheauthorsforventuringintothisareathatassesstheconsecutiverecurrencefollowingearlysuccessofintermittentexotropia[X(T)]surgeryandtodeterminetheclinicalfactorsthataffectthesurvival.However,wewouldliketomakethefollowingcomments.Inthepresentstudy,itwasdiscussedaboutthecorrelationofearlypostoperativeovercorrectionwithlong-termoutcomes.ItisknownthatmostauthorswouldagreetoanearlypostoperativeovercorrectioninadultpatientswithX(T),the

简介：Objective:Theobjectiveofthecurrentstudywastoevaluatethefeasibilityandsafetyofnonintubateduniportalvideo-assistedthoracoscopicsurgery（VATS）forthemanagementofprimaryspontaneouspneumothorax（PSP）.Methods:FromNovember2011toJune2013,32consecutivepatientswithPSPweretreatedbynonintubateduniportalthoracoscopicbullectomyusingepiduralanaesthesiaandsedationwithoutendotrachealintubation.Anincision2cminlengthwasmadeatthe6thintercostalspaceinthemedianaxillaryline.Thepleuralspacewasenteredbybluntdissectionforplacementofasoftincisionprotector.Instrumentsweretheninsertedthroughtheincisionprotectortoperformthoracoscopicbullectomy.Datawerecollectedwithinaminimumfollow-upperiodof10months.Results:Theaveragetimeofsurgerywas49.0min（range,33-65min）.Nocomplicationswererecorded.Thepostoperativefeedingtimewas6h.Themeanpostoperativechesttubedrainageandhospitalstaywere19.3hand41.6h,respectively.Thepostoperativepainwasmildfor30patients（93.75%）andmoderatefortwopatients（6.25%）.Norecurrencesofpneumothoraxwereobservedatfollow-up.Conclusions:Theinitialresultsindicatedthatnonintubateduniportalvideo-assistedthoracoscopicoperationsarenotonlytechnicallyfeasible,butmayalsobeasafeandlessinvasivealternativeforselectpatientsinthemanagementofPSP.ThisisthefirstreporttoincludetheuseofanonintubateduniportaltechniqueinVATSforsuchalargenumberofPSPcases.Furtherworkanddevelopmentofinstrumentsareneededtodefinetheapplicationsandadvantagesofthistechnique.

简介：无

简介：AbstractBackground:Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO2) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO2 in the forearm and that in the thigh.Results:We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.Conclusion:Muscular tissue desaturation, defined as a baseline SmtO2 < 80% in the forearm, may be associated with an increased risk of POP.Trial registration:No. ChiCTR-ROC-17012627.

简介：AIMTo把主要、周期性的pterygium外科的长期的结果与三种不同技术作比较：联合结膜自体移植和覆盖羊膜的膜移植(有AMT的猫)，结膜自体移植移植(猫)独自一个、羊膜的膜移植(AMT)alone.METHODSIn这回顾的研究，142个pterygium病人的142只眼睛(104主要，38周期性)经历了猫(组A)，AMT(组B)或有AMT(组C)的猫分别地后面的外科的切除基于复发和手术后的complications.RESULTSThe数字被考察并且比较一样的描述在下面)，18(10，8)并且2(1，1)在组A，B，和C分别地；干燥眼睛是22(16，6)，27(18，9)并且7(3，4)；结膜发炎是30(17，13)，27(16，11)并且11(6，5)。在组C(主要或周期性的任何一个或两个)的病人主要在组A或B比那些显示出显著地更好的结果(P<0.05)关于上述临床的effects.CONCLUSIONCombined猫并且过分AMT比猫或AMT为主要、周期性的pterygium外科有复发和手术后的复杂并发症的显著地更低的率独自一个。

简介：AbstractPancreatic surgery contains several major procedures of pancreatectomy. Surgical trauma, severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients. Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up, including preoperative nutritional screening, perioperative nutrition assessment and intervention. The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery. However, few high-grade evidences have been published and controversy still exists. This review aims to reflect the current situation, consensus and controversy of perioperative nutrition management in pancreatic surgery, expecting to provide necessary guidance for clinical research and practice.

简介：AbstractMalaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.

简介：DearSir,IamDr.Yin-HungChangfromtheDepartmentofOtolaryngology,TaipeiTzuChiHospital,theBuddhistTzuChiMedicalFoundation.Iwouldliketopresentacaseofinvertedpapillomawithcarcinomachangeoflacrimaldrainageapparatusandnasalcavitythathadbeensuccessfullytreatedbyendoscopicsurgery.Lacrimaldrainageapparatustumorsarerarebutimportant

简介：AIMTo评估剩余的excimer激光修正的功效和安全在有intraocular的奔流抽取以后的折射错误透镜(IOL)培植在不平常cases.METHODSTotally有高剩余的24个病人在有IOL培植的奔流外科以后的折射错误被检验。22个病人有phacoemulsification和IOL培植的历史，并且二与IOL培植有囊外的奔流抽取。外科手术前的医药记录的详细检查被做解释奔流以后的折射错误的起源。所有病人经历了photorefractirekeratectomy(PRK)改进。吝啬的结果措施是折射，uncorretted视觉尖酸(UCVA)，最好改正的视觉尖酸(BCVA)和角膜的透明性并且列在后面在上面从1到剩余变常眼的8y.RESULTSThe主管原因是在有高近视和先天的透镜畸形的反常眼睛的不精确的IOL计算，两个都由角膜的散光列在后面导致的缝术并且先存在。在奔流外科以后并且在激光改进前，吝啬的球形的等价物(SE)是-0.56?潢吗？